JoHo

Over the past century, clinical assessment methods have been developed to facilitate diagnosis, treatment (planning), and research. In doing so, attention has been and still is given to the flexibility, adaptive nature, and integration with other (assessment) fields, such as neurosciences and education. Lastly, a trend has emerged in recent years toward computer-based assessment techniques.

What is clinical neuropsychology?

Clinical neuropsychology is an applied science focused on the behavioral expression of brain dysfunction. It owes its concepts to those who puzzled about what people made people do what they did and how. These people first called attention to what seemed to be linkages between body structures and people’s common response to common situations and behavioral anomalies. In the nineteenth century the idea of controlled observations became generally accepted. In the first half of the twentieth century, war-damaged brains gave the chief impetus to the development of clinical neuropsychology. Neuropsychological programs were created for the First World War (WW-I) for screening and diagnosis of brain injured and behavioral disturbed servicemen and for their rehabilitation afterwards. The Second World War (WW-II) promoted the development of many talented neuropsychologists and of increasingly sophisticated examination and treatment techniques.

Which three domains contributed to the development of clinical neuropsychology?

Clinical neuropsychology can trace its lineage directly to the clinical neurosciences. Psychology contributed to the two other domains of knowledge and skills that are integral to the scientific discipline and clinical practices of neuropsychology today. First, educational psychologists (beginning with Binet) initially developed tests to capture a construct named "intelligence". Such intelligence tests (for example: Raven's Progressive Matrices, the Wechsler Intelligence Scales and so forth) have been developed for screening recruits and are now integrated into the neuropsychological test canon. Second, experimental studies of cognitive functions in both humans and other animals offer an important contribution to the field of neuropsychology. Animal studies and clinical reports of humans with brain injury, in particular soldiers with localized wounds and stroke patients, offered much information about the alternations and limitations of specific cognitive functions when one part of the brain is lacking or compromised.

In sum, the following three domains contributed to the development of clinical neuropsychology: (1) clinical neuroscience; (2) educational psychology; (3) experimental studies of cognitive functions in both humans and other animals.

What are the six examination purposes of a neuropsychological examination?

The practice of neuropsychology calls for flexibility, curiosity, inventiveness, and empathy even in seemingly most routine situations. A neuropsychological examination may be prompted by any of the following six examination purposes:

1. Diagnosis: Accurate diagnosis, including localization of a lesion, is often achieved by means of the neurologist’s examination and laboratory devices. Still conditions may not be diagnostically enlightening (for example Alzheimer). In such circumstances, a neuropsychological assessment needed. Despite general similarities in the pattern of brain function sites, these patterns will differ more or less between patients and thus the outcome will be different. Screening is another aspect of diagnosis.

2. Patient’s care and planning: Many patients are referred for detailed information about their cognitive status, behavioral alterations, and personality characteristics. Often asked questions here concern their adjustment to their disabilities. These questions are asked so that they and the people responsible for their wellbeing gather information about how the neurological condition has affected their behavior. When all the data of a comprehensive neuropsychological examination (think of: the patient’s history, background, and present situation, the qualitative observations, and quantitative scores) are taken together, the examiner should have a realistic appreciation of how the patient reacts to deficits and can best compensate for them, and whether and how retraining could be profitably undertaken. Deterioration on repeated testing can identify a dementing process early in its course. Repeated testing may also be used to measure the effects of surgical procedures, medical treatment, or retraining. Brain impaired patients must have factual information about their functioning to understand themselves and to set realistic goals, yet their need for this information is often overlooked. The family needs to know about their patient’s condition in order to respond appropriately.

3. Treatment-1: Treatment planning and remediation: In today's society, the application of neuropsychological knowledge and interventions that are based on this knowledge require additional assessment demands: (1) sensitive, (2) broad gauged, and (3) accurate neuropsychological assessment is needed for determining the most appropriate treatment for each rehabilitation candidate with brain dysfunction. This includes delineation of problem areas and evaluation of the patient’s strengths and potential for rehabilitation.

4. Treatment 2: Treatment evaluation: Related to the continually increasing use of rehabilitation and retraining services, we are nowadays more faced with questions regarding the worth of these services. How effective is a particular intervention? Do the benefits outweigh the costs of the intervention, both monetarily and in expenditure of professional time? Here, again, neuropsychological assessment can help answering these questions. Consumers and referring clinicians need to ask whether a given service promises more than can be delivered, or whether what is produced in terms of the patient’s behavioral changes has psychological or social value and is maintained long enough to warrant the costs.

5. Research: Neuropsychological assessment has been used and still is used to study the organization of brain activity and its translation into behavior, and to investigate specific brain disorders and behavioral disabilities. Research with neuropsychological assessment techniques also involves their development, standardization and evaluation.

6. Forensic Neuropsychology: Neuropsychological assessment can be used for legal proceedings, for instance claims of bodily injury and loss of function criminal cases, misbehavior, questions about mental capacity to stand trial. The neuropsychologist may uncover vocational or family problems, or patient care needs that have been overlooked, or the patient may prove to be a suitable candidate for research.

To conclude, neuropsychological assessment can be used for various purposes. Six common purposes are: (1) diagnosis; (2) patient care and planning; (3) treatment: planning and remediation; (4) treatment: evaluation; (5) research, and; (6) forensic neuropsychological, in particular legal proceedings.

How to assess the validity of neuropsychological assessment?

A commonly asked question about the usefulness of neuropsychological assessment concerns the ecological validity. Ecological validity typically refers to how well the neuropsychological assessment data reflect everyday functioning or predict future behavior or behavioral outcomes.

What can we expect of neuropsychological assessment at the beginning of this new century?

The first citation that used the term "clinical neuropsychology" has been published in 1963. The first citation that used the term "neuropsychological assessment" followed in 1970. By 2011, almost 56,000 articles are related to neuropsychological assessment, as listed by the National Library of Medicine. This number shows a powerful acknowledgement of the importance of neuropsychological assessment for understanding brain function, cognition, and behavior.

Nowadays, a new trend is emerging. In general we see an increase in various applications of neuropsychological assessment in both clinical and theoretical research in medicine, the neurosciences, education, and the social sciences as well. In particular more and more computer-based assessment programs are now available. The need for increasingly sensitive statistical techniques for test evaluation combined with the progress in computer-based assessment has led to improvements in tasks, procedures, possibilities, and effectiveness of neuropsychological assessment.

Specific challenges for neuropsychological assessment are as follows. Neuropsychological assessment techniques should be adaptive and integrated with other assessment methods, yet in such a way that neuropsychology remains its unique role while simultaneously contributing to the larger clinical neuroscience, psychological, and medical knowledge base. Second, its dispersion to other cultures and language groups than for which the assessment instrument was originally developed offers a measure of the degree to which neuropsychology has become an accepted and valued partner in both clinical and research enterprises.

To conclude, neuropsychological assessment in the future should be flexible for a great variety of persons and problems, yet specific enough to answer particular questions and meet specific needs of patients. One means to achieve this goal is by developing a series of relatively short fixed batteries designed for use with (clusters of) particular diseases or disorders. The neuropsychologist, then, would have a set of test modules at his or her disposal, tailored for a specific cluster of diseases or disorders.